Inactivity & Immobility Flashcards
____ is a person’s ability to move around freely in his/her environment
Mobility
___ inability to move around freely
Immobility
Is an intervention in which the client is restricted to bed for therapeutic reasons
Bed rest
mobility is also related to body changes from aging
▫️loss of muscle mass
▫️reduction in muscle strength and function
▫️joint becoming stiffer and less mobile
▫️gait changes affecting balance can significantly compromise the mobility of elder patients
without the stress of weight-bearing activity, bones demineralize.
disuse osteoporosis
When muscle fibres are not able to shorten or lengthen
-a permanent shortening (as of muscle) forms, limiting joint mobility
Contractures
without movement connective tissue at joint becomes _________ (permanently immobile)
ankylosed
As bone demineralize, excess calcium may move to joints, contributing to stiffness and pain.
calcium leaves the bones and goes to joint cavity, or goes to blood and kidneys and become CALCULI
A pathological reduction in normal size of muscle fibres after prolonged inactivity from bed rest, trauma, casting, or local nerve damage.
Disuse atrophy
What are the intervention to decrease atrophy complications?
▫️body repositioning ▫️weight bearing activities ▫️deep breathing and coughing exercise ▫️compression stockings ▫️high protein,calories and fibre diet
Impaired venous return to heart if pooling in extremities
Thrombus formation
Decreased mobility (CVS) can lead to ⬆️ in ♥️rate ____
reflex becomes dormant, blood pools in extremities _____
tachycardia
orthostatic hypotension
Bed rest can restrict chest movement. Abdominal organs push against the diaphragm (when laying in bed) restricting lung movement - difficult to expand the lungs fully = shallow respiration’s. fluid gets in the lungs causes atelectasis which leads to pneumonia
poor oxygen exchange at alveolar level
A stagnation in the normal flow of bodily fluids, such as the blood or urine. Even with voiding in laying position - not emptied completely. ⬆️risk for UTI
Urinary stasis
Immobility = excessive amounts of urine calcium (extracts from bones). The calcium salts precipitate out as crystals to form _____
Renal Calculi
Immobility effects to GI due to decreased peristalsis and colon motility
Constipation
Immobility impedes circulation and diminishes the supply of nutrients to specific area of the skin that causes.
Skin breakdown
Nursing intervention for immobility/ inactivity
▫️allow patient to perform tasks at his or her own rate
▫️maintain limbs in functional alignment
▫️turn position every 2 hours, or as needed.
Is a chronic, progressive metabolic bone disease.
-low bone mass, structural deterioration of bone tissue, causing fragility and risk of fracture
Osteoporosis
Predisposing factors for Osteoporosis:
- Long-term corticosteroid use (interferes with bone metabolism)
- Prolonged immobilization (usage stimulates “remodeling” - absorption and depositing of bone)
- Nutritional deficiency
Symptoms of Osteoporosis: Often not until later stages of disease “silent disease”
▫️sudden back pains
▫️a decrease in height
▫️kyphosis which is a spine curvature due to bone breakage
Osteoporosis diagnostic Evaluation
▫️DEXA scan (dual energy X-ray Absorptiometry)
▫️Bone density is the most important predictor of fracture risk
**diagnostics don’t diagnose until 25-40% bone density is lost
Modifiable risk factors of osteoporosis (behavioural)
▫️inactivity
▫️alcohol abuse
▫️cigarette smoking
Pharmacological therapy for osteoporosis
▫️Biphosphates (⬇️ rates of bone reabsorption -inhibits osteoclasts activity)
▫️thyroid hormones (slow rate of osteoclasts activity)
▫️selective estrogen-receptor modulators (SERMs)
-estrogen supports bone formation, post menopausal women at risk of OP
▫️Parathyroid hormones
-stimulates bone formation
It’s an inflammation of a joint
Arthritis
It’s a slowly progressing, non-inflammatory disorder of synovial joints.
Cartilage wears down over time. Patients may experience a painful bone-on-bone articulation.
*Cartilage destruction and inadequate repair
Osteoarthritis
What are the causes of osteoarthritis?
▫️⬇️ of estrogen production (women) ▫️genetics ▫️obesity ▫️exercise ▫️high joint impact sports (soccer, football)
Osteoarthritis symptoms:
▫️joint pain (asymmetric) worsening with movement, often relieves with rest (early stages)
▫️joint stiffness (worst in the morning -long rest period)
▫️pain can ⬆️ w changes in barometric pressure
▫️particular mov‘t becomes difficult: sitting, rising from chair
▫️bcoz OA is a non-inflammatory disease, systemic manifestation are not present
Osteoarthritis management:
Drug therapy:
Supplement:
Complementary/alternative:
▫️NSAIDs
▫️glucosamine and chondroitin sulphate
▫️yoga, massage therapy, acupuncture
Three factors collectively predispose a client to the formation of thrombophlebitis (a clot that is loosely attached to an inflamed vein wall)
▫️impaired venous return to heart
▫️hypercoagulability of blood
▫️injury to a vessel wall
A thrombus is dangerous if it breaks loose becoming an ____
▫️Embolus
___% of hip fractures are osteoporosis related
80%
Modifiable risk factor (nutritional)
▫️low calcium intake
▫️low vit.D intake
▫️caffeine intake (⬇️ GI calcium absorption)
Is an infection of the bone caused by staphylococcus aureus
Osteomyelitis
Infection of the bone occurs as a result of:
▫️extension of soft-tissue infection
▫️direct bone contamination (injury)
▫️bloodborne spread from another site of infection (wound)
First line treatment to prevent necrosis in Osteomyelitis
▫️aggressive and prolonged IV therapy (think PICC line)
What will be the risk for extension of infection in osteomyelitis?
▫️bone abscess formation, then cell death
Osteoporosis vs Osteoarthritis
Osteoporosis: loss of bone mass, ⬆️ing risk for fractures
Osteoarthritis: degeneration of a joint (knees, wrists, fingers, toes, and hips)
Is a chronic, systematic autoimmune disease characterized by inflammation of connective tissue in synovial joints
▫️fluctuates between remission and exacerbation
Rheumatoid Arthritis
Rheumatoid arthritis management:
▫️rest ▫️joint protection ▫️hot/cold application ▫️exercise ▫️management/prevention of nodular involvement (internal organs)
Primary goals in managing RA:
▫️decrease inflammation
▫️manage pain
▫️maintain joint function
▫️prevent or correct joint deformity
Inadequate joint movement can result in progressive____ and ___
Joint immobility and muscle weakness
Over aggressive exercise (OA) can result in _____
⬆️ pain, inflammation and joint damage
_____ exercise (OA) are usually done daily to keep joints functional
gentle ROM
It is a systematic inflammatory disease involving _____, _____ , and _____. No specific test or cures.
3 specific presentation such as: ___, ____ and ____
▫️joints, connective tissue, and viscera
▫️ systemic, polyarticular and pauciarticular
(same as adults -mostly spleen)
Supplement use to manage Osteoporosis?
▫️glucosamine and chondroitin sulphate
Areas in the body mostly at risk for fracture in young adults due to sports?
Femoral shaft fracture
How do you position Client post op hip assessment?
▫️reduce edema (elevate with pillows)
▫️maintain proper alignment - avoid external rotation (pillow between knees, splint, sandbags)
▫️pain
What populations are at greater risk for disuse atrophy?
▫️elderly (frail elderly)
▫️physically disabled
🔸bcoz they don’t have the same capacity to rebuild muscle
What would be an assessment for immobility/ inactivity?
▫️assess skin integrity
▫️assess nutritional needs as they relate to immobility
▫️evaluate need for assistive devices
▫️evaluate the safety of the immediate environment
